Abdominal distension bloating

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The principal causes of abdominal distension arc far. flatus, faeces, fluid aiul fetus (Table 5.10). Increasing abdominal girlh is usually due to adiposity and should alert the clinician to the possibility of alcohol abuse. Its development in a patient who is otherwise becoming thinner suggests intra-abdominal disease.

Ascites, the accumulation of fluid in the peritoneal cavity, is usually due to cirrhosis of the liver, malignancy, nephrotic syndrome, tuberculous peritonitis, cardiac or pericardial disease. The acute development of tense ascites suggests intra-abdominal malignancy, infective peritonitis or the onset of hepatic or portal vein obstruction.

Painless abdominal distension in women may be the presenting symptom of an ovarian cyst or of an undisclosed pregnancy. It is also a feature of pseudo obstruction, i.e. non-mechanical obstruction, often seen in neuropathy affecting the gastrointestinal tract, and in elderly patients

TABLE 5.10

Causes of abdominal distension

Factor

Consider

Fat

Excessive alcohol consumption

Flatus

Pseudo-obstruction, obstruction

Faeces

Subacute obstruction, constipation

Fluid

Ovarian or uterine mass Biadder enlargement Ascites

Fetus

Date of the last menstrual period

TABLE 5.9 Functional dyspepsia Type Symptom subset

Reflux-like Acid reflux and heartburn relieved by antacids

Ulcer-like Localised epigastric pain and nocturnal pain

Relief with vomiting, food or antacids

Dysmotility-like Nausea, belching, premature satiety, bloating and abdominal distension taking drugs with anticholinergic effects, such as tricyclic antidepressants. Painless abdominal distension and constipation from early childhood in the absence of faecal soiling suggests the possibility of Hirschsprung's disease. Fluctuating abdominal swelling which develops during the day hut resolves overnight is particularly common in women and is rarely if ever due to organic disease. It usually occurs with other symptoms of the irritable bowel syndrome, namely abdominal pain relieved by defecation and altered bowel habit. Painful abdominal distension suggests intestinal obstruction associated with intestinal colic. Chronic simple constipation rarely produces painful distension unless associated with the irritable bowel syndrome.

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